Fine needle aspiration in hepatocellular carcinoma: combined cytologic and histologic approach

Abstract

Most previous reports on fine needle aspiration (FNA) of hepatocellular carcinoma (HCC) described only the morphology of the tumour cells, without considering the sinusoidal stroma. Cytohistological correlation from the same aspirate has rarely been done. This report describes the cytological patterns of 40 cases of HCC in terms of histological patterns observed in cells blocks prepared from the same aspiration specimen and classified according to the WHO Classification. The FNA was performed by the radiologist and pathologists with and without image guidance respectively. Smears were prepared by the air-dried rehydration technique and agar blocks were prepared from tissue fixed in 7.5% formalin. 27 cases were of the trabecular pattern, one of pseudoglandular pattern and 12 of compact pattern. In smears, the tabecular pattern was divided into a central-sinusoidal pattern (21 cases) and a peripheral-sinusoidal pattern (6 cases). The former featured sinusoids flanked by tumour hepatocytes; in the latter endothelium surronded tumour trabeculae. In all 40 cases, sinusoids were easily recognized in cell block sections. In conclusion, attention should be paid to the sinusoidal stroma for diagnosis of HCC in FNA; cell blocks should be more widely utilized to this effect; cytological patterns could be classified according to the WHO Classification.